Aceclofenac, a Preferential COX-2 Inhibitor - Appraisal of Safety and Tolerability

BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly used medications to reduce inflammation and pain in clinical practice. The main concern with their use is gastrointestinal and cardiovascular side effects due to inhibition of gastroprotective prostaglandins and imbalance of prostacyclin and thromboxane respectively. NSAIDs function by inhibiting the cyclooxygenase (COX) enzymes. Evidence shows the occurrence of these side effects even with their short term use. Development of NSAID with a goal of superior or similar efficacy but with lower incidences of side effects resulted in the introduction of aceclofenac. Classified as a preferential COX-2 inhibitor, aceclofenac inhibits the COX-2 enzyme preferentially (97 %) as compared to COX-1 (46 %). Lesser inhibition of the COX-1 enzyme results in lower incidences of GI side effects. Also, due to preferential COX-2 selectivity, aceclofenac balances vascular homeostasis and thus has minimal CV risk. The diversity of COX-1 and COX-2 selectivity in NSAIDs has proven clinically important. Encouraging clinical evidence shows that aceclofenac has a favourable safety profile amongst NSAIDs. Our goal in this manuscript is to give a narrative review of clinical evidence of aceclofenac’s safety and tolerability. Based on the data, we can conclude that aceclofenac is an effective analgesic in both acute and chronic inflammatory conditions, with a comparatively low risk of gastrointestinal and cardiovascular adverse effects. This favourable tolerability profile of the drug reflects a reduction in cost associated with adverse events management, from both patient’s and healthcare provider’s perspectives.